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Okay, after several consults with Dr. Jeffries and a second opinion, I have more information. Mel (in addition to SM) may have a vertebrae in his spine that is overlapping his skull in the general direction of his brain. We are going to do a CT scan to confirm this, but the surgery proposed for Mel is directed at removing this obstruction. Dr. Jeffries is proposing that we take this route as opposed to the graft or mesh surgery and is hopeful it will relieve some of his symptoms. Neither neurologist I spoke with seemed to have much confidence in the grafting or mesh procedures and this scares/depresses me. Mel's syrinx is considerably large and I do feel that some additional measures must be taken, I feel responsible for his condition and how severe it is. Every time Mel had a crying fit I took him to the vet and so many of them just kept telling me he was too young to have SM. I wanted to believe them so much I ignored my suspicions and called him quirky.
Karlin, Your right about it seeming sudden. Though I wasn't surprised at his diagnosis I feel every change (anticipated or current) in our lives so acutely I don't know what to do. When Mel isn't around to be upset by me, I cry so profusely. I vacillate from angry to sad so much during these times, I feel like I'm a crazy person.
In the end, I am sure I feel as all of you do. I just want to help him so much, to make him better no matter the cost- and no one can give us the guarantee we so badly need.

So is he talking about a laminectomy (or a laminotomy) as well as decompression of the foramen magnum and duraplasty (but without any swine tissue or titanium mesh graft)? Did you hear any of those words used? Or is he talking about doing a laminectomy only and NO decompression (removing the piece of bone from the skull)?

I looked back at my notes from the 2010 AVMA lectures - the one from Dr. Andy Shores - and copied this:

"Also, on the subject of "more" decompression, it seems to me that the laminectomy at C1 that Dr. Shores does results in further decompression, albeit decompression of the spinal cord rather than the brain." Dr. Shores was doing a laminectomy at C1 on all of his decompression surgeries.

Mel's mum wrote: I feel responsible for his condition and how severe it is. The only people who are in some measure responsible for Mel's condition are the breeders over the years who have not taken SM seriously - it didn't suddenly appear with MRI scans, people have had screaming dogs and still continued to breed from them or their progeny long before that. And many vets just don't do their homework on how widespread SM is in Cavaliers and what the symptoms are. And it takes a lot of confidence for a lay person to disagree with their vet and demand a second opinion. If I had known more, I would have queried my Oliver's early symptoms long before he was diagnosed at the age of 6. And I'm more and more certain that my Cavalier before Oliver had quite serious SM and probably spent his 10 years of life in considerable pain - but he had other health issues that confused the situation and none of us recognised it or did anything about it. So don't beat yourself up too badly - SM presents with so many different symptoms that we all miss some and only recognise them with hindsight.

Dr. Jeffries indicated that he was not planning on doing the foramen magnum and duraplasty at this time (just the removal of the vertibral bone). Should I ask him about doing both? I would hate for Mel to have to go through surgery... but that sounds insanely intense.

I agree with what Kate said. Please don't beat yourself up because you are doing all you can now. I too wondered if I only did something sooner or did I not notice this... How long did I think it was ear infections, allergies, etc. It is so hard and like Kate said symptoms can mimic so many things. Take care of yourself as well as Melvin.

You can only go by what information your doctor is giving you and trust that your doctor is giving you the best information for your dog. It sounds as if Dr. Jeffries is very well known and respected. I would ask about the implant or skull decompression to see if he thinks that Mel might be a candidate for it later on down the road, but that this is the more immediate problem right now. Maybe once the pressure is released, he'll do fine on medication. At some point you have to put your faith and trust in your doctor, make a decision, and go with it. Realize that it was a hard decision and other people may not agree with it, but you made it wth the best information you had in front of you at the time. And you made it with only love for Mel in your heart, because you want him to grow up to be an old cavalier, and to live as pain-free and as happy of a life as he can, running and jumping and playing and enjoying life. No one can ever fault you for whatever decision you make with that in mind. Mel is a lucky dog to have you and we support you.

Realize that it was a hard decision and other people may not agree with it, but you made it wth the best information you had in front of you at the time. And you made it with only love for Mel in your heart, because you want him to grow up to be an old cavalier, and to live as pain-free and as happy of a life as he can, running and jumping and playing and enjoying life. No one can ever fault you for whatever decision you make with that in mind. Mel is a lucky dog to have you and we support you.

Could not have said it better. I know I shared my experience earlier but I felt and still feel I made the best decision. It is the hardest decision but we are here for you.

Thank all of you so much for what you have said. It means so much to me to hear consolation and support from those who have been through this before. Hindsight is really kicking me right now, but I'm trying not to focus on it so I can move forward and get Mel the help he needs. I will keep you up to date as we do. Dr. Jeffries has been great and very welcome to discussing all of my questions for the past three days, so after much deliberation (and several late night discussions) we booked our hotel and scheduled his surgery for Tuesday 3/19.